/ CONJOINT APPOINTMENT APPLICATION FORM

Before completing this form please read the University of Newcastle’s Honorary Appointments Policy.

1Updated December 2013

/ CONJOINT APPOINTMENT APPLICATION FORM
Title:Prof A/Prof Dr Mr Mrs Ms
Name of Applicant:
Postal Address:
Postcode:
Preferred Email Address: .
Discipline:
Date of Birth: Male Female

Name of Current Employer:

Work Address:
Position Title:

NOTE:Applications for appointment as Conjoint Professor, Conjoint Associate Professoror Conjoint Professor of Practiceshould include details of three referees.At least two should be external referees who are recognised as authorities in the relevant field or profession. For Conjoint Professor and Conjoint Associate Professorit is desirable that senior referees are nominated, eg at or above the level aspired to and recognised at national and international level.

Referee Details: Title & Nameeg Professor Jim Smith / Position Details eg. Dean, Faculty of Law, Monash / Contact Details
Email:
Phone:
Fax:
Email:
Phone:
Fax:
Email:
Phone:
Fax:

1.Please indicate the recommended level of appointment (refer toAppendix 2 - Criteria for Assessing Academic level on the University website

Fellow / Lecturer / Senior Lecturer / Associate Professor / Professor / Professor of Practice

2.Qualifications and achievements (refer toAppendix 2 - Criteria for Assessing the Level of ConjointAppointment on the University website

Current Curriculum Vitae must be attached.

CV is attached Yes

1Updated December 2013

The University of Newcastle / Conjoint Appointment Application Form

3. Indicative Support

The resources available to the conjoint appointee will be discussed and agreed with the Head of School/Pro Vice-Chancellor as appropriate. These resources will be identified in the letter of offer.

4.Areas of actual or planned contribution to the Faculty/School (to be completed in consultation with the applicant):

The applicant has contributed/will contribute to the Faculty/School through:

Small group teaching and tutoring

Preparing and presenting fixed resource sessions/lectures

Working problem tutoring

Preparing and marking written assessments

Viva assessment

University postgraduate supervision (coursework or research)

Attendance at Faculty committee meetings

Curriculum development

Research in the area of

Other or Special projects, please state:

RECOMMENDATION For Appointment AS A CONJOINT

I recommend that …………………………………………………….…………. be appointed as a Conjoint at the following level:

Fellow / Lecturer / Senior Lecturer / Associate Professor / Professor / Professor of Practice

Signature of Head of School...... ……………………………………………………………….…….….

Name (Please print): …………………..………………….……………………….. Date: …...……...... ….……

For appointments up to Senior Lecturer:

Signature of Faculty Executive Group representative

at Professorial level from another Faculty: .…………….……………………………………………….………....….

Name (Please print)……………………………………………………………..………

Position Title…………………….…………..………………………………………….. Date:……...... …………

APPROVE / DECLINE (delete as appropriate) CONJOINT APPOINTMENT AT RECOMMENDED LEVEL

Fellow / Lecturer / Senior Lecturer

Signature of Pro Vice-Chancellor: …………………..…………………….….………………………………………….

Name (Please print): …………….……………………….…………………..……….. Date: ………...... ………

PRO VICE-CHANCELLOR SUPPORT FOR RECOMMENDATION AT PROFESSORIAL LEVEL

I support the recommendation that …………………………………………………………..………………………….. be appointed as a Conjoint at the following level:

Associate Professor / Professor / Professor of Practice

in the School of ………………………………………………….………… Faculty of ………………….…………………

Reasons for support: …………………..…………………………….…………………………………….….…………...

………………………...…………………………………………………………….…………………………….………….…

………………………………………………………………………………………………………………………….…..……

Signature of Pro Vice-Chancellor:……………….………………….….….………………...... …...…

Name (Please print): …………….……………………….…………………..……….. Date: ………...... ………

University Professorial Conjoint Advisory Committee

I support/do not support (delete as appropriate) Conjoint appointment at recommended level:

Deputy Vice-Chancellor(Academic)Signature:……………………….………Date:……….………...………..

Comments: …………………..…………………………….…………………………………….….…………...

………………………...…………………………………………………………….…………………………….………….…

………………………………………………………………………………………………………………………….…..……

I support/do not support (delete as appropriate) Conjoint appointment at recommended level:

Deputy Vice-Chancellor

(Research)Signature:…………………….…………Date:…………….…..………...

Comments: …………………..…………………………….…………………………………….….…………...

………………………...…………………………………………………………….…………………………….………….…

………………………………………………………………………………………………………………………….…..……

I support/do not support (delete as appropriate) Conjoint appointment at recommended level:

President of Academic Senate Signature:…………………….…………Date:…………….…..…….…..

Comments: …………………..…………………………….…………………………………….….…………...

………………………...…………………………………………………………….…………………………….………….…

………………………………………………………………………………………………………………………….…..……

APPROVE / DECLINE (delete as appropriate) CONJOINT APPOINTMENT AT RECOMMENDED LEVEL

Signature of Vice-Chancellor: ………………..…………………………….….……Date: ……….…….………………

Comments: …………………..…………………………….…………………………………….….…………......

………………………...…………………………………………………………….…………………………….………….…

………………………………………………………………………………………………………………………….…..……

………………………...…………………………………………………………….…………………………….………….…

1Updated December 2013